link
Bookmarks
Chronic Hypertensive Encephalopathy
Miral D. Jhaveri, MD, MBA
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
5
19
0

KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Chronic hypertensive encephalopathy (CHE)
            • Synonyms

              • Subcortical arteriosclerotic encephalopathy
                • a.k.a. Binswanger disease
              • Hypertension (HTN)-related microvascular disease
              • Hypertensive microangiopathy
            • Definitions

              • Brain parenchymal changes due to longstanding effects of untreated or poorly treated systemic HTN
                • CHE is most common cause of leukoaraiosis [diffuse rarefaction of white matter (WM)]
                  • Others include diabetes
              • CHE: Important cause of cognitive deficits caused by vascular disease (i.e., vascular dementia)

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Wang Y et al: Intracranial atherosclerotic disease. Neurobiol Dis. 124:118-32, 2019
                                            2. Carnevale L et al: Brain MRI fiber-tracking reveals white matter alterations in hypertensive patients without damage at conventional neuroimaging. Cardiovasc Res. 114(11):1536-46, 2018
                                            3. Haller S et al: Cerebral microbleeds: imaging and clinical significance. Radiology. 287(1):11-28, 2018
                                            4. Regenhardt RW et al: Advances in understanding the pathophysiology of lacunar stroke: a review. JAMA Neurol. 75(10):1273-81, 2018
                                            5. Rosenberg GA: Binswanger's disease: biomarkers in the inflammatory form of vascular cognitive impairment and dementia. J Neurochem. 144(5):634-43, 2018
                                            6. Pu Y et al: Intracranial atherosclerosis: from anatomy to pathophysiology. Int J Stroke. 12(3):236-45, 2017
                                            7. Suzuki H et al: Abnormal brain white matter microstructure is associated with both pre-hypertension and hypertension. PLoS One. 12(11):e0187600, 2017
                                            8. Prins ND et al: White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol. 11(3):157-65, 2015
                                            9. van Dalen JW et al: Cortical microinfarcts detected in vivo on 3 Tesla MRI: clinical and radiological correlates. Stroke. 46(1):255-7, 2015
                                            10. Marsh EB et al: Predicting symptomatic intracerebral hemorrhage versus lacunar disease in patients with longstanding hypertension. Stroke. 45(6):1679-83, 2014
                                            11. Ritz K et al: Cause and mechanisms of intracranial atherosclerosis. Circulation. 130(16):1407-14, 2014
                                            12. Cheng AL et al: Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Stroke. 44(10):2782-6, 2013
                                            13. Wardlaw JM et al: Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 12(5):483-97, 2013
                                            14. Bastos-Leite AJ et al: Cerebral blood flow by using pulsed arterial spin-labeling in elderly subjects with white matter hyperintensities. AJNR Am J Neuroradiol. 29(7):1296-301, 2008
                                            15. Della Nave R et al: Whole-brain histogram and voxel-based analyses of diffusion tensor imaging in patients with leukoaraiosis: correlation with motor and cognitive impairment. AJNR Am J Neuroradiol. 28(7):1313-9, 2007
                                            16. O'Sullivan M et al: Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis. J Neurol Neurosurg Psychiatry. 75(3):441-7, 2004
                                            17. Wardlaw JM et al: Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke. 34(3):806-12, 2003
                                            18. Catani M et al: Proton magnetic resonance spectroscopy reveals similar white matter biochemical changes in patients with chronic hypertension and early Alzheimer's disease. J Am Geriatr Soc. 50(10):1707-10, 2002
                                            Related Anatomy
                                            Loading...
                                            Related Differential Diagnoses
                                            Loading...
                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Chronic hypertensive encephalopathy (CHE)
                                                      • Synonyms

                                                        • Subcortical arteriosclerotic encephalopathy
                                                          • a.k.a. Binswanger disease
                                                        • Hypertension (HTN)-related microvascular disease
                                                        • Hypertensive microangiopathy
                                                      • Definitions

                                                        • Brain parenchymal changes due to longstanding effects of untreated or poorly treated systemic HTN
                                                          • CHE is most common cause of leukoaraiosis [diffuse rarefaction of white matter (WM)]
                                                            • Others include diabetes
                                                        • CHE: Important cause of cognitive deficits caused by vascular disease (i.e., vascular dementia)

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Wang Y et al: Intracranial atherosclerotic disease. Neurobiol Dis. 124:118-32, 2019
                                                                                      2. Carnevale L et al: Brain MRI fiber-tracking reveals white matter alterations in hypertensive patients without damage at conventional neuroimaging. Cardiovasc Res. 114(11):1536-46, 2018
                                                                                      3. Haller S et al: Cerebral microbleeds: imaging and clinical significance. Radiology. 287(1):11-28, 2018
                                                                                      4. Regenhardt RW et al: Advances in understanding the pathophysiology of lacunar stroke: a review. JAMA Neurol. 75(10):1273-81, 2018
                                                                                      5. Rosenberg GA: Binswanger's disease: biomarkers in the inflammatory form of vascular cognitive impairment and dementia. J Neurochem. 144(5):634-43, 2018
                                                                                      6. Pu Y et al: Intracranial atherosclerosis: from anatomy to pathophysiology. Int J Stroke. 12(3):236-45, 2017
                                                                                      7. Suzuki H et al: Abnormal brain white matter microstructure is associated with both pre-hypertension and hypertension. PLoS One. 12(11):e0187600, 2017
                                                                                      8. Prins ND et al: White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol. 11(3):157-65, 2015
                                                                                      9. van Dalen JW et al: Cortical microinfarcts detected in vivo on 3 Tesla MRI: clinical and radiological correlates. Stroke. 46(1):255-7, 2015
                                                                                      10. Marsh EB et al: Predicting symptomatic intracerebral hemorrhage versus lacunar disease in patients with longstanding hypertension. Stroke. 45(6):1679-83, 2014
                                                                                      11. Ritz K et al: Cause and mechanisms of intracranial atherosclerosis. Circulation. 130(16):1407-14, 2014
                                                                                      12. Cheng AL et al: Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Stroke. 44(10):2782-6, 2013
                                                                                      13. Wardlaw JM et al: Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 12(5):483-97, 2013
                                                                                      14. Bastos-Leite AJ et al: Cerebral blood flow by using pulsed arterial spin-labeling in elderly subjects with white matter hyperintensities. AJNR Am J Neuroradiol. 29(7):1296-301, 2008
                                                                                      15. Della Nave R et al: Whole-brain histogram and voxel-based analyses of diffusion tensor imaging in patients with leukoaraiosis: correlation with motor and cognitive impairment. AJNR Am J Neuroradiol. 28(7):1313-9, 2007
                                                                                      16. O'Sullivan M et al: Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis. J Neurol Neurosurg Psychiatry. 75(3):441-7, 2004
                                                                                      17. Wardlaw JM et al: Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke. 34(3):806-12, 2003
                                                                                      18. Catani M et al: Proton magnetic resonance spectroscopy reveals similar white matter biochemical changes in patients with chronic hypertension and early Alzheimer's disease. J Am Geriatr Soc. 50(10):1707-10, 2002